Cara Membaca Analisis Gas Darah Arteri (AGDA).ppt
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Transcript of Cara Membaca Analisis Gas Darah Arteri (AGDA).ppt
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BLOOD GAS ANALYSIS
Hasanul Arifin Departemen Anestesiologi dan ReanimasiDepartemen Anestesiologi dan Reanimasi
FKUSU – RSUP. H. Adam Malik FKUSU – RSUP. H. Adam Malik MedanMedan
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Apa yang Apa yang dibaca ?dibaca ?
pH, PaCO2, BEpH, PaCO2, BE
HCO3, PaO2, HCO3, PaO2, SaO2SaO2
Hasanul-2004
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STEPS IN ACIDS BASE CLASSIFICATION
1. pH Classification
2. PaCO2 Classification
3. Metabolic Classification
4. Compensation Evaluation
5. Complete Acid-Base Classification
Hasanul-2004
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pH Classification
Classification
Normal
Acidosis
Alkalosis
pH
7.35-7.45
< 7.35
>7.45
Hasanul-2004
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Classification of Laboratory
Respiratory Acid-Base Component
Classification
Normal Resp.ComponentNormal Resp.Component
Respiratory AcidosisRespiratory Acidosis
Respiratory AlkalosisRespiratory Alkalosis
PaCO2 (mmHg)
35-4535-45
>45>45
<35<35
Hasanul-2004
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Classification of Laboratory
Metabolic Acid-Base Component
Classification
Normal Metab.Component
Metabolic Acidosis
Metabolic Alkalosis
BE
0±2
< -2
> +2
HCO3
24±2
<22
>26
Hasanul-Hasanul-20042004
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Langkah LangkahLangkah Langkah
• Baca pH Baca pH normal, normal, acidosisacidosis, , alkalosisalkalosis• Lihat PaCO2 atau BE, mana yg searah dengan pHLihat PaCO2 atau BE, mana yg searah dengan pH• Bila Bila PaCO2PaCO2 yang searah yang searah respiratorik respiratorik sebagai sebagai
proses primerproses primer• Bila Bila BEBE yang searah yang searah metabolikmetabolik sebagai proses sebagai proses
primerprimer• Bila Bila proses primerproses primer sudah diketahui, lihat dimana sudah diketahui, lihat dimana
posisi komponen yg lain :posisi komponen yg lain : Bila berlawanan Bila berlawanan proses kompensasi proses kompensasi Bila searah Bila searah proses ganda proses ganda Bila posisi normal Bila posisi normal belum atau tidak ada proses belum atau tidak ada proses
kompensasikompensasi
hasanul-2004
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7,357,35
4545
-2-2
2222
7,457,45
3535
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
Eddy Rahardjo1990/Hasanul-2004
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pH : 7.28, PaCO2 : 40, BE : -10pH : 7.28, PaCO2 : 40, BE : -10
7,357,35
4545
-2-2
2222
7,457,45
3535
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
7.287.28
-10-10
4040
Acidosis metabolik tanpa Acidosis metabolik tanpa kompensasikompensasi
hasanul-2004
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pH : 7.32, PaCO2 : 55, BE : +1pH : 7.32, PaCO2 : 55, BE : +1
7,357,35
4545
-2-2
2222
7,457,45
3535
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
7.327.32
Acidosis respiratorik tanpa Acidosis respiratorik tanpa kompensasikompensasi
5555
++11
hasanul-2004
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7,357,35
4545
-2-2
2222
7,457,45
35 35
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
pH : 7,50 ; PaCO2 : 30 ; BE : -2 ;pH : 7,50 ; PaCO2 : 30 ; BE : -2 ;
7,507,50
3030
Alkalosis respiratorik tanpa Alkalosis respiratorik tanpa kompensasikompensasi hasanul-2004
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7,357,35
4545
-2-2
2222
7,457,45
35 35
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
pH : 7,55 ; PaCO2 : 30 ; BE : +5 ;pH : 7,55 ; PaCO2 : 30 ; BE : +5 ;
7,557,55
3030
Alkalosis respiratorik dan metabolik Alkalosis respiratorik dan metabolik (proses ganda)(proses ganda)
+5+5
Hasanul-2004
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Steps in Evaluation and Classification of Acid-Base Compensation
1. Evaluate for the presence of Evaluate for the presence of compensationcompensation
2.2. Determine the probable primary Determine the probable primary problemproblem
3.3. Classify the degree of compensationClassify the degree of compensationHasanul-2004
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Determination of the primary
problempH 7.40-7.45
pH 7.35-7.40
Alkalosis is primary
Acidosis is compensatory
Acidosis is primary,
Alkalosis is compensatory Hasanul-2004
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Classification of degree of Compensation
pH
7.35-7.45
<7.35
>7.45
Degree of compensation
Complete
Partial
PartialHasanul-2004
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7,357,35
4545
-2-2
2222
7,457,45
35 35
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
pH : 7,48 ; PaCO2 : 30 ; BE : -6 ;pH : 7,48 ; PaCO2 : 30 ; BE : -6 ;
7,487,48
3030
Alkalosis respiratorik dgn kompensasi Alkalosis respiratorik dgn kompensasi parsialparsial
-6-6
hasanul-2004
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pH : 7.32, PaCO2 : 30, BE : -10pH : 7.32, PaCO2 : 30, BE : -10
7,357,35
4545
-2-2
2222
7,457,45
3535
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
7.327.32
-10-10
3030
Acidosis metabolik dgn Acidosis metabolik dgn kompensasi kompensasi parsialparsial
hasanul-2004
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pH : 7.38, PaCO2 : 30, BE : -10pH : 7.38, PaCO2 : 30, BE : -10
7,357,35
4545
-2-2
2222
7,457,45
3535
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
-10-10
3030
Acidosis metabolik dgn Acidosis metabolik dgn kompensasi kompensasi penuhpenuh
7,387,38
Hasanul-2003
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7,357,35
4545
-2-2
2222
7,457,45
35 35
+2+2
2626
pHpH
PaCOPaCO22
BEBE
HCOHCO33
ACIDOSISACIDOSIS ALKALOSIALKALOSISS
pH : 7,43 ; PaCO2 : 30 ; BE : -6 ;pH : 7,43 ; PaCO2 : 30 ; BE : -6 ;
7,437,43
3030
Alkalosis respiratorik dgn kompensasi Alkalosis respiratorik dgn kompensasi penuhpenuh
-6-6
Hasanul-2003
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CLASSIFICATION of PaOCLASSIFICATION of PaO22
CLASSIFICATIONCLASSIFICATION
HyperoxemiaHyperoxemia
NormoxemiaNormoxemia
Mild hypoxemiaMild hypoxemia
Moderate Moderate hypoxemiahypoxemia
Severe hypoxemiaSevere hypoxemia
AdultAdult
>100>100
80-10080-100
60-7960-79
45-5945-59
<45<45
NewbornNewborn
>90>90
60-9060-90
50-5950-59
40-4940-49
<40<40
PaOPaO2 2 (mmHg)(mmHg)
Hasanul-2003
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Severity of Generalized Acid-Base Severity of Generalized Acid-Base disturbancesdisturbances
pHpH
<7,20<7,20
7,20-7,297,20-7,29
7,30-7,347,30-7,34
7,35-7,457,35-7,45
7,46-7,507,46-7,50
7,51-7,557,51-7,55
>7,55>7,55
Degree of Degree of ImpairmentImpairment
Severe AcidosisSevere Acidosis
Moderate Moderate AcidosisAcidosis
Mild AcidosisMild Acidosis
Normal pHNormal pH
Mild AlkalosisMild Alkalosis
Moderate Moderate AlkalosisAlkalosis
Severe AlkalosisSevere Alkalosis
Hasanul-2003
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Normal Arterial GasesNormal Arterial Gases
ParameterParameter
pHpH
PaCOPaCO22
PaOPaO22
SaOSaO22
ValuesValues
7,35-7,457,35-7,45
35-45 mmHg35-45 mmHg
80-100 mmHg80-100 mmHg
98-100%98-100%Hasanul-2003
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Normal mixed venous gasesNormal mixed venous gases
ParameterParameter
pHpH
PaCOPaCO22
PaOPaO22
SaOSaO22
ValuesValues
7,387,38
48 mmHg48 mmHg
40 mmHg40 mmHg
75%75%Hasanul-2003
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1. 7,58 20 19 63
2. 7,44 52 34 28
3. 7,21 66 26 47
4. 7.44 31 20 111
5. 7,60 28 27 59
6. 7,50 50 37 75
7. 7,41 42 25 229
8. 7,52 41 32 49
9. 7,44 28 35 87
10. 7,44 35 23 97
No. pH PaCO2 HCO3 PaO2 ClassificationNo. pH PaCO2 HCO3 PaO2 Classification
Hasanul-2003
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1. 7.32 30 -10 58
2. 7.52 34 +4 32
3. 7.36 32 - 4 145
4. 7.42 30 - 5 90
5. 7.20 50 - 9 60
6. 7.20 80 +2 90
7. 7.55 25 0 72
8. 7.34 30 - 9 41
9. 7.37 56 +4 57
10. 7.40 38 - 2 350
No.No. pH PaCO2 BE PaO2 ClassificationpH PaCO2 BE PaO2 Classification
Hasanul-2003
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Kam Kam shiashia
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